Juveniles commit a significant number of the sexual assaults against
children and women in this country. The onset of sexual offending behavior
in these youth can be linked to numerous factors reflected in their experiences,
exposure, and/or developmental deficits. Emerging research suggests that,
as in the case of adult sex offenders, a meaningful distinction can be
made between youth who target peers or adults and those who offend against
children. However, juveniles who sexually offend are distinct from their
adult counterparts. Youth who commit sexual offenses are not necessarily
"little adults;" many will not continue to offend sexually. This is a formative
area of research; while there is an ever-increasing body of knowledge regarding
the etiologies of dysfunction and aggression, there remains a tremendous
need for additional data to understand the etiology of juveniles sexual
offending.

The purpose of this brief is to discuss the current state of research
on sexually abusive youth, legislative trends, and promising approaches
to the treatment and supervision of these youth.

Research Developments

Characteristics of Juvenile Sexual Abuse

Sexual aggression perpetrated by young people has been a growing concern
in the United States over the past decade. Currently, it is estimated that
juveniles account for up to one-fifth of all rapes and almost one-half
of all cases of child molestation committed each year (Barbaree et al,
1993, Becker et al, 1993, Sickmund et al, 1997). Adolescents age 13 to
17 account for the vast majority of cases of rape and child molestation
perpetrated by minors (Davis and Leitenberg,1987). The majority of incidents
of juvenile sexual aggression involve male perpetrators (Sickmund et al,
1997). However, a number of clinical studies also point to prepubescent
youths and females engaging in sexually abusive behaviors. Although racial
and socioeconomic differences may be over represented in certain settings
(e.g., juvenile justice), juveniles referred for treatment in a variety
of environments reflect the same racial, religious, and socioeconomic distribution
as the general population of the United States (Ryan et al, 1996).

In 1995, youth were involved in 15 percent
of all forcible rapes that resulted in arrest; approximately 18 adolescents
per 100,000 (ages 10 to 17) were arrested for forcible rape in 1995.
Approximately 16,100 adolescents were arrested for sexual offenses in 1995
(excluding rape and prostitution). This is approximately 3 times
the number of youths arrested for forcible rape (Sickmund et al, 1997).

A number of etiological factors (risk factors) have been identified to
help explain the developmental origin of sexual offending. Factors receiving
the most attention are abusive experiences and exposure to aggressive role
models.
Other factors in focus are substance abuse and exposure to pornography;
however, these are seen more as disinhibitors than as causal influences.

The Effects of Physical and Sexual AbuseRecent studies show that rates of abusive histories vary widely for
sexually abusive youth. A history of physical abuse has been found in 20
to 50 percent of these youth; a history of sexual abuse has been found
in 40 to 80 percent of sexually abusive youth (Hunter and Becker, 1998,
Kahn and Chambers, 1991). Rates of physical abuse and sexual victimization
are even higher in samples of prepubescent and young female sexual abusers
(Gray et al,1997, Mathews et al, 1997). Research suggests that age of onset,
number of incidents of abuse, the period of time elapsing between the abuse
and its first report, as well as perceptions of familial responses to awareness
of the abuse are all relevant in understanding why some sexually abused
youths go on to commit sexual assaults while others do not (Hunter and
Figueredo, in press).

The influence of abusive experiences is considered multi-faceted and
includes effects related to both Post-Traumatic Stress Disorder and modeling
(Freeman-Longo, 1986, Gil and Johnson, 1992). Symptoms of Post-Traumatic
Stress Disorder have been observed in a number of youths with sexual behavior
disorders, especially children ages 13 and younger and females. These symptoms
include recurrent and intrusive recollections of past traumatic events
and increased levels of irritability and anger. Youths who have directly
experienced or witnessed sexual abuse may imitate the behavior of the aggressive
role model(s) in their interactions with others.

The presence of child maltreatment—whether neglect, physical abuse,
sexual abuse, or other forms of victimization—may eventually prove to be
a significant predictor of sexual offending behavior.

Exposure to Aggressive Role ModelsStudies show that male child witnesses to domestic violence tend to
engage in externalizing behaviors (the acting-out of psychological conflict
or tension), including acts of interpersonal aggression, more than their
female counterparts (Stagg et al, 1989). Exposure to family violence is
linked to the likelihood of sexually offending as an adolescent, as well
as the severity of psychosexual disturbance (Fagan and Wexler, 1988, Smith
1988). The effects of exposure may be cumulative, as well as interactive
with other developmental experiences, such as child abuse and neglect (O’Keefe,
1994). Recent studies suggest that exposure to severe community violence
(e.g., murders) may also increase the likelihood of engaging in violent
and antisocial behavior (Johnson-Reid, 1998).

Substance Abuse and Exposure to PornographyWhile there is strong research to support the association between violent
crime and alcohol use, the association between sexual offending and substance
abuse is not fully established. Estimates of the extent of substance abuse
vary widely for the population of youth who sexually offend (Lightfoot
and Barbaree, 1993). The influence of pornography on the developing male’s
potential for sexual offending is an issue of similar controversy. One
recent study found that sexually abusive youth were exposed to pornographic
material at younger ages on the average, and to "harder core" pornography,
than either status offenders or violent non-sex offending youths (Ford
and Linney, 1995). Research in these areas is lacking and clearly, juvenile
sexual offending is far more complex than simple exposure to pornography
or substance abuse.

Developmental ProgressionWhile sexual aggression may emerge early in the developmental process,
there is no evidence to suggest that the majority of sexually abusive youth
become adult sex offenders. Recidivism rates for these youth may have been
exaggerated by a reliance on retrospective research studies (studies that
examine historical data), which can overstate the strength of correlations.
Longitudinal studies (studies that examine current data), which tend to
be more reliable, suggest that aggressive behavior in youths often does
not continue into adulthood, although some portion of those who commit
rape may continue to abuse (Elliott, 1994, Loeber and Stouthamer-Loeber,
1998).

Other Characteristics Common to Sexually Abusive YouthSexually abusive youth share other common characteristics, including:

The clinical and criminal dimensions of juvenile male sexual abusers
often vary. As with their adult counterparts, juvenile sexual abusers fall
primarily into two major types: those who target children and those who
offend against peers or adults. The distinction between these two groups
is based on the age difference between the victim and the perpetrator (child
perpetrators are those who target children five or more years younger than
themselves).

The following table examines distinctions in characteristics between
these two groups of sexually abusive youth.

Comparing Two Sub-Groups of Sexually Abusive Youth

Characteristics:

Offend
Against Peers or Adults

Offend
Against Children

Victims

Predominantly assault females.

Assault mostly strangers or acquaintances (Hunter et al, in press).

Females victimized at slightly higher rates.

Nearly half assault at least one male.

Up to 40 percent of victims are either siblings or relatives (Hunter et
al, in press).

Offense Patterns

More likely to commit in conjunction with other criminal activity.

More likely to commit offenses in public areas (Hunter et al, in press).

Reliance on opportunity and guile, particularly when victim is a relative.

More likely to use weapons and cause injuries to their victims (Awad and
Saunders, 1989, Monto et al, 1998).

Frequently display signs of depression (Becker et al, 1991).

Youths with severe personality and/or psychosexual disturbance may display
high levels of aggression and violence (Becker and Hunter, 1993).

Deviant Sexual InterestsA minority of sexually abusive youth manifest established paraphilic
(deviant) sexual arousal and interest patterns. These arousal and interest
patterns are recurrent and intense, and relate directly to the nature of
the sexual behavior problem (e.g., sexual arousal to young children). Deviant
sexual arousal is more clearly established as a motivator of adult sexual
offending, particularly as it relates to pedophilia. A small subset of
juveniles who sexually offend against children may represent cases of early
onset pedophilia. Research has demonstrated that the highest levels of
deviant sexual arousal are found in juveniles who exclusively target young
male children, specifically when penetration is involved (Hunter and Becker,
1994, Marshall et al, 1991). In general, the sexual arousal patterns of
sexually abusive youth appear more changeable than those of adult sex offenders,
and relate less directly to their patterns of offending behavior (Hunter
and Becker, 1994, Hunter et al, 1994).

Treatment Research

While funding and ethical issues have made it difficult to conduct carefully
controlled treatment outcome studies, a number of encouraging clinical
reports on the treatment of sexually abusive youth have been published
(Becker and Hunter, 1997). While these studies are not definitive, they
provide support for the belief that the majority of sexually abusive youth
are amenable to, and can benefit from, treatment.

MST is an intensive family- and community-based treatment that addresses
the multiple factors of serious antisocial behavior in juvenile abusers.
Treatment can involve any combination of the individual, family, and extrafamilial
(e.g., peer, school, or neighborhood) factors. MST promotes behavior change
in the youth’s natural environment, using the strengths of the youth’s
family, peers, school, and neighborhood to facilitate change.

In this study, rearrest records were used as a measure of sexual and
non-sexual recidivism; the groups were compared at a three-year follow-up
interval. Results revealed that youths receiving multisystemic therapy
had recidivism rates of 12.5 percent for sex offenses and 25 percent for
non-sex offenses, while those receiving individual therapy had recidivism
rates of 75 percent for sex offenses and 50 percent for non-sex offenses.

Other Treatment ResearchProgram evaluation data suggests that the sexual recidivism rate for
juveniles treated in specialized programs ranges from approximately 7 to
13 percent over follow-up periods of two to five years (Becker, 1990).
Furthermore, juveniles appear to respond well to cognitive/behavioral and/or
relapse prevention treatment, with recidivism rates of approximately seven
percent through follow-up periods of more than five years (Alexander, 1999).
Studies suggest that rates of non-sexual recidivism are generally higher
(25 to 50 percent) (Becker, 1990, Kahn and Chambers, 1991, Schram et al,
1991). Findings from outcome studies on adult offenders show higher sexual
recidivism rates for individuals who fail to successfully complete treatment
programs (Marques et al, 1994).

In a recently conducted study, Hunter and Figueredo found that as many
as 50 percent of youths entering a community-based treatment program were
expelled during the first year of their participation (Hunter and Figueredo,
1999). Those who failed the program had higher overall levels of sexual
maladjustment, as measured on assessment instruments, and were judged to
be at greater long-term risk for sexual recidivism.

Policy Development Issues

Trends in Juvenile Justice

The rise in juvenile perpetrated violence over the past decade has resulted
in legislation designed to enhance public safety and raise the level of
accountability of juveniles in the criminal justice system (Hunter and
Lexier, 1998). Substantive changes have been made in legal statutes or
regulatory policy in over 90 percent of the states. These reforms include
changes related to:

juvenile court waivers;

sentencing guidelines;

record confidentiality;

community notification;

registration requirements for sex offenders; and

correctional programming.

The number of delinquency cases waived to adult criminal courts increased
by 71 percent between 1985 and 1994 (Szymanski, 1998). The age at which
a juvenile may be tried as an adult has been lowered in over half of the
states. Twenty jurisdictions (AK, AZ, DE, DC, FL, GA, ME, MD, NE, NV, OH,
OK, OR, PA, RI, SC, TN, WA, WV, and WI) have no minimum age restriction
for trying a juvenile as an adult for certain serious crimes (Szymanski,
1998). Legislative changes have also made it more likely that once a juvenile
is convicted of a crime in the adult courts, he or she will serve at least
some minimum sentence (Office of Juvenile Justice and Delinquency Prevention,
1997). Presently, more than half of the states permit public access to
juvenile court records with some age and offense restrictions, while eleven
states (AZ, AR, CO, FL, IA, MI, MT, NV, NM, TX, and WA) permit public juvenile
hearings with no age or crime restrictions (Szymanski, 1998).

Registration and Community Notification LawsThe registration and tracking of individuals convicted of violent sex
crimes or crimes against minors began with the passing of the 1994 Jacob
Wetterling Act. The Wetterling Act was amended in 1996, with the passage
of "Megan’s Law," which requires (as opposed to authorizing) state and
local law enforcement agencies to release information that is necessary
to protect the public concerning a specific person required to register.
The Pam Lychner Sexual Offender Tracking and Identification Act of 1996
created criteria for mandatory lifetime registration of highly-dangerous
sex offenders, penalties for failure to register, and a requirement that
the FBI create a national sex offender registry to assist law enforcement
in tracking sex offenders when they move.

Idaho’s Juvenile RegistryIdaho maintains a registry of juveniles adjudicated of
sexual offenses, separate from the adult registry. This registry
is open to public inspection, and is shared with the superintendent of
public instruction who then notifies public and private schools regarding
the enrollment of any registered juveniles. In Idaho, juveniles are
required to register annually until they reach the age of 21, at which
time a prosecutor can file a petition to have the youth transferred to
the adult registry. If no petition is filed, the juvenile is deleted
from the registry.

Under federal guidelines, states are not required to register juveniles
who are adjudicated delinquent for a sex crime. However, states may require
registration for these youth if they wish to do so. Juveniles convicted
as adults are required to register under provisions of these guidelines
(Department of Justice, Office of the Attorney General, 1998). At least
27 states have enacted registration laws for juveniles convicted (or adjudicated)
of sex crimes. In some states, juveniles are subjected to the same registration
requirements as adult sex offenders. In others, juveniles register until
they reach a certain age (e.g., 18 or 21); in some instances, the court
may require continued registration as an adult sex offender once a juvenile
reaches that age.

Promising Approaches to Intervention

The number of programs providing treatment services to juvenile sex
abusers more than doubled between 1986 and 1992, and continues to climb.
This growth reflects both increased societal concern about rising rates
of juvenile sex offenses and the professional belief that early intervention
helps to stem the emergence of chronic patterns of sexual offending. The
following is a review of issues essential to the development of successful
community-based treatment programming for sexually abusive youth.

Coordination between the Criminal Justice System and
Treatment Providers

Most treatment specialists believe that successful programming for sexually
abusive youth requires a coordinated effort between criminal justice system
actors and treatment providers (National Task Force on Juvenile Sexual
Offending, 1993). For juveniles to productively participate in treatment
programming, they must be willing to address their problems and comply
with therapeutic directives. Adjudication and supervision typically prove
useful in ensuring client accountability and compliance with treatment,
as well as a means to prevent future victimization.

Clinical experience has demonstrated that the suspension of the youth’s
sentence contingent upon his or her successful completion of a treatment
program is a particularly effective motivator. Under collaborative arrangements,
the treatment specialist provides ongoing progress reports to the courts.
Those youth who fail to comply with program expectations can be brought
back before the court for review.

Alternative Disposition in Washington
StateIn Washington State, the court has the option to order
a treatment sentence for most sexually abusive youth. Under the Special
Sex Offender Disposition Alternative (SSODA), the judge can suspend the
offender’s sentence, place the offender on community supervision for up
to two years, and require the juvenile to participate in treatment with
a state-certified therapist. The state pays the cost of treatment.
If an offender does not comply with sentence conditions, or if the judge
determines that the juvenile is not making adequate progress in treatment,
the disposition may be revoked and a determinate sentence imposed.
The law allows courts to remove the registration requirement for any juvenile
after he or she has fulfilled sentence requirements (Lieb, 1998).

SupervisionTo date, no studies have been conducted that clearly identify which
supervision strategies are most effective with these youth. However, research
on adult sex offender supervision suggests that model management strategies
involve: intensive supervision and sex offense specific treatment; interagency
collaboration, multidisciplinary teams, and the specialization of supervision
and treatment staff; the use of the polygraph to monitor therapy and compliance
with supervision conditions; and program monitoring and evaluation, which
ensure prescribed policies and practices are delivered as planned (English
et al, 1996). However, there has been little research on the application
of adult conditions to juveniles. Too little is yet known about young perpetrators
to apply adult standards to them.

The Role of Supervision OfficersIn many programs, parole and probation officers play an integral role
in assisting treatment providers by addressing critical issues and supervising
youths’ activities in the home and community. Parole and probation officers
help evaluate the extent to which clients are productively participating
in the treatment program and complying with court and therapeutic directives.
They provide an additional link between the provider and youths’ families,
and often assist therapists in impressing upon families the importance
of their involvement in the youths’ rehabilitative programming. In some
instances, parole and probation officers participate directly in the delivery
of therapeutic services as co-therapists in treatment groups. While there
is little consensus among the treatment community about the proper role
of supervision officers in the treatment of young sexual abusers, supervision
officers should, at a minimum, communicate and collaborate with treatment
providers.

Pilot Program: Jefferson County, ColoradoIn Jefferson County, when juveniles are arrested for
a sex offense, they are taken to an assessment center and administered
a risk-screening instrument. This instrument determines whether these
youth will be detained or allowed to remain in the community, either at
home or in another alternative placement such as foster care. The
assessment center works with the family and youth, and can refer family
members to community counseling, if necessary. Under this process,
treatment can start before sentencing occurs.

Juveniles start probation at the highest level of supervision.
They are sentenced to probation for a maximum of two years. Youth
participate in a risk and protective factor process to determine the most
applicable treatment. Probation officers meet frequently with treatment
providers, and in some instances, they may attend treatment sessions about
once a month to observe first hand their clients’ progress in treatment.
Juveniles are also administered polygraphs and plethysmographs when therapists
or probation officers feel they are needed. Conditions of probation
include the need to comply with polygraph or plethysmograph assessment
if deemed useful by the treatment provider.

Jefferson County also has established a county-wide case
management team for juveniles, consisting of pre-trial and probation supervision
staff, treatment providers, a child advocacy center representatives, staff
from the prosecutor’s office and the schools. This team meets monthly
to assess each case and work together to ensure that both clients and victims
are receiving optimal service.

In May 1998, the juvenile supervision guidelines developed
by the Jefferson County unit were recommended for use throughout Colorado.

Typically, parole and probation officers provide an essential case management
function. This includes analysis (sometimes with the help of social services)
of the appropriateness of youth receiving in-home treatment and of the
need for supplemental community programming, such as community service
projects. As case managers, parole/probation officers also facilitate appropriate
communications between treatment providers and other community agencies,
such as school officials involved in the youths’ overall care.

Assessment

Careful screening is critical to the success of community-based programming.
Ideally, this assessment reflects the careful consideration of the danger
that the perpetrator presents to the community, the severity of psychiatric
and psychosexual problems, and the juvenile’s amenability to treatment.
The latter issues involve an assessment of the youth’s level of accountability
for his or her sex offenses, motivation for change, and receptivity to
professional help. Professionals who are experienced working with sexually
abusive youth should conduct these evaluations. Programs should not compromise
community safety by admitting youths who are more aggressive and violent,
those who have psychiatric problems that are beyond the scope of the community-based
program, or those who demonstrate little regard for their actions or interest
in receiving help.

Clinical AssessmentProfessional evaluation of youth and their appropriateness for placement
should be conducted post-adjudication and prior to court sentencing. Clinical
assessments should be comprehensive and may include careful record review,
clinical interviewing, screening for co-occurring psychiatric disorders,
and the administration of both specialized psychometric instruments designed
to assess sexual attitudes and interests, as well as those related to more
global personality adjustment and functioning.

Specialized Assessment
Instruments

Multiphasic Sex Inventory (Nichols and Molinder, 1984)

Adolescent Cognitions Scale (Hunter et al, 1991)

Adolescent Sexual Interest Card Sort (Hunter et al, 1991)

Inventories Appropriate
for Children with Sexual Behavior Problems

Child Sexual Behavior Inventory (Friedrich et al, 1991)

General Assessment Instruments

MMPI-A (Archer, 1997)

Child Behavior Checklist (Achenbach et al, 1987)

Family Environment Scale (Moos and Moos, 1986)

Child and Adolescent Functional Assessment Scale (Hodges et al, 1982)

Adjunctive Assessment Tools*

Plethysmograph

Polygraph

(*There is little research on these tools to determine whtether they are
effective on juvenile populations.)

Assessment of the Youth’s HomeAssessments of the juvenile’s appropriateness for community-based programming
should include a thorough review of his or her living arrangements, as
well as a determination as to whether his or her parents are capable of
supervising the youth. Proper assessment requires evaluation of whether
the living environment affords the level of structure and supervision necessary
for the youth while providing for the safety of others in the home and
the community. Special consideration must be given to the needs and concerns
of individuals living in the home who may have been victimized by the youth
(e.g., younger siblings). It is essential that other children are protected
from potential harm, both physical and psychological. It is often necessary
to place a juvenile who sexually offends against family members temporarily
outside of the home. These youth should not be returned home until sufficient
clinical progress is attained, and issues of safety and psychological comfort
of family members are resolved. For an adjudicated youth, this decision
is typically made by the presiding judge with input from the parole/probation
officer and social services worker, the youth’s treatment provider, the
provider of services to family victim(s), and the youth’s family.

Clinical Programming

Clinical programming for sexually abusive youth typically includes a
combination of individual, group, and family therapies. In addition, many
programs offer supportive educational groups to families of these youth.
Juveniles who display more extensive psychiatric or behavioral problems,
such as substance abuse, may require additional treatment, including drug
and alcohol rehabilitation and psychiatric care. All therapies provided
to sexually abusive youth should be carefully coordinated within the treatment
agency and with external agencies providing case management and oversight.
Treatment programs need to be individually tailored through a thorough
assessment of the youth, family, and environment.

Providers have established the following as essential components of
the treatment process:

Gaining control of behavior.

Teaching the impulse control and coping skills needed to successfully manage
sexual and aggressive impulses.

Enhancing social skills to promote greater self-confidence and social competency.

Programming designed to enhance empathy and promote a greater appreciation
for the negative impact of sexual abuse on victims and their families.

Provisions for relapse prevention. This includes teaching youths to understand
the cycle of thoughts, feelings, and events that are antecedent to the
sexual acting-out, identify environmental circumstances and thinking patterns
that should be avoided because of increased risk of reoffending, and identify
and practice coping and self-control skills necessary for successful behavior
management.

Teaching and clarifying values related to respect for self and others,
and a commitment to stop interpersonal violence. The most effective programs
promote a sense of healthy identity, mutual respect in male-female relationships,
and a respect for cultural diversity.

Providing sex education to give an understanding of healthy sexual behavior
and to correct distorted or erroneous beliefs about sexual behavior.

The planning and implementation of treatment services ideally reflect the
collaborative involvement of the youth, family, and all agencies involved
in the youth’s care as well as those agencies serving victims of these
youth. Often, this is accomplished by forming an advisory board to oversee
the operation of the program and serve as a mediator between the program
and the community. These boards typically consist of representatives from
public institutions serving youths and families, including the local juvenile
court, the department of social services, the prosecutor’s office, the
public defender’s office, victim advocacy services, and parents of youthful
perpetrators. The advisory board helps to ensure that the treatment program
is serving the needs of its clients while meeting community safety standards.

Controversial Areas of Practice

The following areas of practice have generated controversy, and therefore
pose special ethical and legal risks for practitioners assessing and treating
sexually abusive youth (Hunter and Lexier, 1998).

Involuntary TreatmentTreatment of juveniles who sexually offend is usually court ordered
or mandatorily provided in correctional settings. Historically, juvenile
courts have prescribed mental health care for youths with an emphasis on
rehabilitation. In contrast, adult courts have typically ordered involuntary
treatment on the grounds that the youth represents an imminent danger to
public safety.

Given the shift of juvenile courts to a more adult-like criminal justice
model, and the increasing frequency with which juveniles are being adjudicated
and tried as adults, the issue of involuntary treatment may need to be
reexamined. Judicial decisions are no longer made with a consistent emphasis
on rehabilitation rather than punishment as a means of ensuring public
safety. However, many sexually abusive youth may not meet the legal criteria
for involuntary treatment based upon imminence of danger criteria.

Pre-Adjudication EvaluationsA number of sexually abusive youth are referred for evaluation prior
to the initiation or completion of the adjudication process. Often, these
referrals are made by the court, or another public agency, in an attempt
to determine the most appropriate disposition for alleged sexual abusers.

Pre-adjudication assessments raise a number of ethical and legal issues.
Youths facing prosecution are placed in the position of being asked to
reveal information that may be used against them in court. Evaluations
present another set of problems associated with the validity of available
assessment instrumentation to determine innocence or guilt. There is no
scientific basis for assuming that any currently available psychometric
or psychophysiological measure of personality or sexual interest is valid
for that purpose (Murphy and Peters, 1992).

Risk AssessmentThe courts frequently give clinicians the responsibility of determining
the youth’s risk of recidivism. These assessments are used to make dispositional
decisions and, as a result of legislative mandates, have potential relevance
in determining which juveniles should be placed on state registries, as
well as whether information about certain sexually abusive youth should
be released to the public.

Unfortunately, risk assessment, especially risk of violence, remains
an inexact science (Borum, 1996, Monahan and Steadman, 1996). Although
a number of risk assessment instruments are emerging as promising in the
assessment of risk of adult sex offenders, to date none of these have been
validated on a juvenile population. At this time, clinicians working with
sexually abusive youth rely on experience, existing research on delinquency
and pro-social functioning of youth, and retrospective and actuarial information
on adults who reoffend in making their evaluations of the risk posed by
a youth.

A recent study has presented encouraging findings on an actuarial scale
for assessing risk among adolescent sexual abusers (Prentky et al, in press).
In this study, the Juvenile Sex Offender Assessment Protocol (J-SOAP) was
used to assess risk on 96 youth receiving treatment in an institutional
setting. Results from a 12-month follow-up period suggest that the instrument
is reliable, internally consistent and appears to possess concurrent and
predictive validity. The J-SOAP is currently being used in a variety of
locations and continues to be the subject of empirical scrutiny.

Phallometric AssessmentPhallometry is a diagnostic method to assess sexual arousal by measuring
blood flow (tumescence) to the penis during the presentation of potentially
erotic stimuli in the laboratory. The plethysmograph is a tool commonly
used in phallometric assessment. Use of the plethysmograph with juveniles
is an issue of some controversy (National Task Force on Juvenile Sexual
Offending, 1993). Research suggests that issues of client age and denial
compromise the validity of plethysmographic assessment of juveniles. Younger
clients appear to produce less reliable patterns of responding, and those
who deny their offenses tend to produce suppressed, and therefore non-interpretable,
patterns of arousal (Becker et al, 1992, Kaemingk et al, 1995). Most practitioners
agree that phallometric assessment should not be used on youth under the
age of 14. Phallometric assessments of sexual arousal patterns are most
appropriate for older adolescent males who report deviant sexual interest,
and/or those juveniles with more extensive histories of sexual offending.
Under these circumstances, such assessments may be useful for identifying
youths with emergent paraphilic (sexual deviation) disorders as well as
helping youth to become more aware of patterns and strengthen non-problematic
interests.

PolygraphThe purpose of a polygraph examination is to verify a perpetrator’s
completeness regarding offense history and compliance with therapeutic
directives and terms of supervision (Edson, 1991, Emerick and Dutton, 1993).
The polygraph is used more often with adult offenders than with juveniles.
To date, there is little research on the polygraph’s reliability and validity
in the evaluation of sexually abusive youth. Research suggests that results
potentially can be affected by a number of influences, including the client’s
physical and emotional status, the client’s age and intelligence, and the
examiner’s level of training and competency (Blasingame, 1998). Most practitioners
using the polygraph indicate that the age threshold for use with juveniles
is approximately 14 years old.

Polygraph Legislation in TexasIn Texas, law requires use of the polygraph on certain
sexually abusive youth. In 1997, legislation was enacted that prescribed
release conditions, including counseling and treatment for adolescents
convicted of certain sex offenses. Under this law, youth can be required,
as a condition of release from the Texas Youth Commission, to attend psychological
counseling sessions and to submit to polygraph examinations in order to
evaluate treatment progress (Texas Human Resources Code, Title 3, Ch. 61,
Sub. A, Sec. 61.0813).

Arousal Conditioning and Psychopharmacologic TherapiesTherapeutic techniques designed to change patterns of sexual arousal
remain controversial. Studies examining the effectiveness of techniques
such as arousal conditioning and drug therapies are inconsistent (Hunter
and Goodwin, 1992). Concerns about the appropriateness of techniques exposing
juveniles to physically or emotionally painful stimuli or involving masturbation
render arousal conditioning questionable (National Task Force on Juvenile
Sexual Offending, 1993). While several reports about the use of drug therapy
have appeared over the past few years, little information exists about
the safety and effectiveness of these drugs when used on juveniles. In
particular, anti-androgens and hormonal agents have typically not been
used with individuals under the age of 18 because of their potential suppression
of growth, and the other yet unknown long term risk that they may present.
Selective Serotonin Reuptake Inhibitors (SSRIs) are helpful in reducing
the frequency and/or intensity of sexual arousal and thoughts. SSRIs are
a class of antidepressant drugs known to cause a decrease in sexual arousal.
Further research is examining the effectiveness of such drugs in reducing
deviant sexual behavior.

Legal and Clinical ConcernsSubjecting juveniles to stricter penalties for sex offenses poses special
legal and clinical concerns. Legal issues can arise in the courtroom when
determining if these youth have the capacity to understand their cases,
to properly consult their attorneys, or to make sound decisions regarding
their defense (Grisso, 1997). Clinical concerns arise when clinicians place
demands on their clients to divulge information that may incur additional
restrictions or legal sanctions. Proper warning regarding the limits of
confidentiality is necessary and may include referral to parents or attorneys
prior to encouraging such disclosures. In many jurisdictions, clinicians
develop policies with district attorneys to clarify the consequences of
new disclosures in the course of treatment (National Task Force on Juvenile
Sexual Offending, 1993). Without these precautions, the reporting of such
information may interfere with the development of the therapist/client
relationship, an essential component of the treatment process, and increase
clinician vulnerability to civil suit (Hunter and Lexier, 1998). As with
adult offenders, these policies must address harm done to victims identified
through new disclosures and ways to offer assistance to these victims.

Areas for Future Research

Continued research is needed in each of the previously described areas.
Research on etiology is especially important to the development of prevention
programming for high-risk youths. Presently, the National Center for Child
Abuse and Neglect is funding two demonstration projects to evaluate treatment
outcomes for pre-pubescent children with sexual behavior problems. Studies
on effective supervision strategies for sexually abusive youth are clearly
needed. Treatment outcome studies that examine both individual and program
characteristics associated with positive treatment outcomes are also needed.
Research should focus on early identification of youths demonstrating patterns
of escalating aggression and violence. The U.S. Department of Justice,
Office of Juvenile Justice and Delinquency Prevention’s currently funded
research on the creation of a typology of juvenile sexual offending behavior
will help mental health and criminal justice professionals better understand
the major subtypes of sexually abusive youth and the most effective intervention
strategies for these groups.

Recommendations for Practice

The following suggestions may be used as guidelines for the ethical
and effective treatment of juveniles who abuse (Hunter and Lexier, 1998).

Clinical Assessments: When possible, clinicians should
conduct evaluations after adjudication and before sentencing. Clinical
assessments should help determine required level of care, identification
of treatment goals and objectives, and estimated risk of reoffending. Clinical
assessment should not be directed at determination of innocence or guilt.

Clinicians’ Roles:Clinicians should carefully explain
their role, as well as the limits of professional confidentiality, to juvenile
clients and their family prior to conducting a clinical interview or administering
assessment tests. Furthermore, it is strongly recommended that consent
forms, releases, and/or waivers addressing these issues be signed by clients
and their families. It is also prudent to review the above issues with
clients’ defense attorneys and/or guardian ad litems representing the youths.

Consent Forms: Clinicians should consider developing additional
consent forms to cover the use of more controversial assessment or treatment
procedures (e.g. phallometric assessment, aversive conditioning, and "off-label"
use of medications). These consent forms should be specific to the procedure
and clearly identify any potential risks associated with it. Clients should
understand that these procedures are voluntary and that they are free to
decline them.

Phallometric and Polygraph Assessments: Phallometric and
polygraph assessments should be administered judiciously. Phallometric
assessment is best limited to males 14 years of age or older with extensive
histories of sexual offending, and/or those who self-report deviant sexual
arousal and interest patterns. This procedure should only be used with
the full, informed consent of the youth, their parent(s) or guardian, and
preferably the referral agency. Furthermore, it should only be used with
those who admit to their offenses and should generally be conducted with
auditory stimuli specifically designed for sexually abusive youth.

Risk Assessment:Clinicians should exercise caution in
rendering judgments of risk that individual juveniles represent for further
sexual offending. This is especially true when these judgments will figure
prominently in legal dispositions. Such assessments should state that they
reflect the best available predictive information on these issues, but
that empirical support for risk models is tentative at present.

Treatment Plans:Clinicians should demonstrate sensitivity
to developmental issues in assessing juveniles with sexual behavior problems
and formulating intervention plans. Treatment plans should be comprehensive,
reflecting a holistic understanding of youths, family systems, and sociocultural
environment in which they live.

Supervision Strategies:Sexually abusive youth have always
been in the community, and have been increasingly identified and supervised
by probation for many years. Only recently has the field moved toward the
development of specialized strategies to manage this unique population.
To be sure, this is an emerging area and one where much is yet to be learned.
However, many of the approaches commonly used with adult sex offenders
(e.g., the use of specialized supervision staff, sex offender specific
treatment providers, and the polygraph) are being adopted by juvenile supervision
agencies around the country. Models of a team approach to sex offender
management—teaming supervision agency staff with therapists, school personnel,
victim advocates and others to work closely with the offender, his/her
family, and victim(s)—are emerging as among the most promising approaches
to sex offender supervision.

Conclusion

Adolescents account for a significant percentage of the sexual assaults
against children and women in our society. The onset of sexual behavior
problems in juveniles appears to be linked to a number of factors, including
child maltreatment and exposure to violence. Emerging research suggests
that, as in the case of adult sex offenders, a meaningful distinction can
be made between juveniles who target peers or adults and those who offend
against children. The former group appears generally to be more antisocial
and violent, although considerable variation exists within each population.
Although available research does not suggest that the majority of sexually
abusive youth are destined to become adult sex offenders, legal and mental
health intervention can have significant impacts on deterring further sexual
offending. Currently, the most effective intervention consists of a combination
of legal sanctions and specialized clinical programming.

The Center for Sex Offender Management would like to thank Dr. John
Hunter for principal authorship of this article. CSOM would also like to
thank Gail Ryan and Lloyd Sinclair for their comments and contributions
to this document. Edited by Madeline M. Carter and Scott Matson, Center
for Sex Offender Management.

Department of Justice, Office of the Attorney General
(1998). Proposed Guidelines for Megan’s Law and the Jacob Wetterling Crimes
against Children and Sexually Violent Offender Registration Act. Federal
Register, June 19, 33696-33708.

Elliott, D.S. (1994). The Developmental Course of Sexual
and Non-Sexual Violence: Results from a National Longitudinal Study.
Paper presented at the meeting of the Association for the Treatment of
Sexual Abusers 13th Annual Research and Treatment Conference, San Francisco,
CA.

Hunter, J.A. & Figueredo, A.J. (in press). The influence
of personality and history of sexual victimization in the prediction of
offense characteristics of juvenile sex offenders. Behavior Modification.

Hunter, J.A. & Figueredo, A.J. (1999). Factors associated
with treatment compliance in a population of juvenile sexual offenders.
Sexual
Abuse: A Journal of Research and Treatment 11, 49-68.

Established in June 1997, CSOM’s goal is to enhance
public safety by preventing further victimization through improving the
management of adult and juvenile sex offenders who are in the community.
A collaborative effort of the Office of Justice Programs, the National
Institute of Corrections, and the State Justice Institute, CSOM is administered
by the Center for Effective Public Policy and the American Probation and
Parole Association

This project was supported by Grant No. 97-WT-VX-K007,
awarded by the Office of Justice Programs, U.S. Department of Justice.
Points of view in this document are those of the author and do not necessarily
represent the official position or policies of the U.S. Department of Justice.